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an acute streptococcal infection characterized by deep-red inflammation of the skin and mucous membranes

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丹毒(たんどく)(連鎖球菌により生じる急性伝染病)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/21 13:08:30」(JST)

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Erysipelas (/ɛrɨˈsɪpələs/; Greek ἐρυσίπελας—red skin; also known as "Ignis sacer", "holy fire", and "St. Anthony's fire"^[1] in some countries) is an acute infection^[2] typically with a skin rash, usually on any of the legs and toes, face, arms and fingers. It is an infection of the upper dermis and superficial lymphatics, usually caused by Beta-hemolytic group A streptococcus bacteria on scratches or otherwise infected areas.^[3] Erysipelas is more superficial than cellulitis, and is typically more raised and demarcated.^[4]

Signs and symptoms

Erysipelas on an arm

Erysipelas on a leg

Affected individuals typically develop symptoms including high fevers, shaking, chills, fatigue, headaches, vomiting, and general illness within 48 hours of the initial infection. The erythematous skin lesion enlarges rapidly and has a sharply demarcated raised edge. It appears as a red, swollen, warm, hardened and painful rash, similar in consistency to an orange peel. More severe infections can result in vesicles (pox or insect bite-like marks), bullae (blisters), and petechiae (small purple or red spots), with possible skin necrosis (skin death). Lymph nodes may be swollen, and lymphedema may occur. Occasionally, a red streak extending to the lymph node can be seen.

The infection may occur on any part of the skin including the face, arms, fingers, legs and toes, but it tends to favour the extremities. Fat tissue is most susceptible to infection, and facial areas typically around the eyes, ears, and cheeks. Repeated infection of the extremities can lead to chronic swelling (lymphangitis).

Cause

Most cases of erysipelas are due to Streptococcus pyogenes (also known as beta-hemolytic group A streptococci), although non-group A streptococci can also be the causative agent. Beta-hemolytic, non-group A streptococci include Streptococcus agalactiae, also known as group B strep or GBS. Historically, the face was most affected; today the legs are affected most often.^[5] The rash is due to an exotoxin, not the Strep. bacteria itself and is found in areas where no symptoms are present - e.g. the infection may be in the nasopharynx, but the rash is found usually on the face and arms.

Erysipelas infections can enter the skin through minor trauma, insect bites, dog bites, eczema, athlete's foot, surgical incisions and ulcers, and often originate from strep bacteria in the subject's own nasal passages. Infection sets in after a small scratch or abrasion spreads resulting in toxaemia.

Erysipelas does not affect subcutaneous tissue. It does not release pus, only serum or serous fluid. Subcutaneous edema may lead the physician to misdiagnose it as cellulitis, but the style of the rash is much more well circumscribed and sharply marginated than the rash of cellulitis.

Risk factors

This disease is most common among the elderly, infants, and children. People with immune deficiency, diabetes, alcoholism, skin ulceration, fungal infections and impaired lymphatic drainage (e.g., after mastectomy, pelvic surgery, bypass grafting) are also at increased risk.

Diagnosis

This disease is diagnosed mainly by the appearance of well-demarcated rash and inflammation. Blood cultures are unreliable for diagnosis of the disease, but may be used to test for sepsis. Erysipelas must be differentiated from herpes zoster, angioedema, contact dermatitis, and diffuse inflammatory carcinoma of the breast.

Erysipelas can be distinguished from cellulitis by its raised advancing edges and sharp borders. Elevation of the antistreptolysin O (ASO) titer occurs after around 10 days of illness.

In Chinese medicine, erysipelas is related to the condition known as Cinnabar Toxin or Fluid Fire (dan du and liu huo in Mandarin), which is caused by Liver Fire moving downwards into the legs, along the Liver Meridian. The condition can be treated with acupuncture and herbal medicine, specifically Long Dan Xie Gan Wan, according to Wiseman and Ye in their Dictionary of Chinese Medicine.

Treatment

Depending on the severity, treatment involves either oral or intravenous antibiotics, using penicillins, clindamycin or erythromycin. While illness symptoms resolve in a day or two, the skin may take weeks to return to normal.

Because of the risk of reinfection, prophylactic antibiotics are sometimes used after resolution of the initial condition. However, this approach does not always stop reinfection.^[6]

Prognosis

Spread of infection to other areas of body through the bloodstream (bacteremia), including septic arthritis. Glomerulonephritis can follow an episode of streptococcal erysipelas or other skin infection, but not rheumatic fever.
Recurrence of infection—Erysipelas can recur in 18–30% of cases even after antibiotic treatment.
Lymphatic damage
Necrotizing fasciitis—commonly known as "the flesh-eating bug". A potentially deadly exacerbation of the infection if it spreads to deeper tissue.

Notable deaths

John of the Cross, Spanish saint and priest (d. 1591)
Father Solanus Casey, American Capuchin priest declared "venerable" by the Roman Catholic Church (d. 1957)^[7]
Samuel Augustus Ward, Victorian gentleman, organist, composer, teacher, businessman (d. 1903)^[8]
Norborne Berkeley, baron de Botetourt, Royal Governor of Virginia (d. 1770)^[9]
Mary Lyon, women's education pioneer (d. 1849)^[10]
John Stuart Mill, British political philosopher (d. 1873)^[11]
Princess Amelia of the United Kingdom, daughter of George III of the United Kingdom (1783 – 1810)
Anne, Queen of Great Britain and Ireland (d. 1714)
Grand Duchess Catherine Pavlovna of Russia, daughter of Tsar Paul I of Russia and wife of King William I of Württemberg (d. 1819)
Frederick VII of Denmark, king of Denmark (d. 1863))^[12]
Christina, Queen of Sweden
Archibald Douglas, 6th Earl of Angus, 6th Earl of Angus (c.1489 – 22 January 1557) was a Scottish nobleman active during the reigns of James V and Mary, Queen of Scots.
Pope Gregory XVI (1765-1846).
George Herbert, 5th Earl of Carnarvon (26 June 1866 – 5 April 1923) was an English aristocrat best known as the financial backer of the search for and the excavation of Tutankhamun's tomb in the Valley of the Kings. His death led to the story of the "Curse of Tutankhamun", the "Mummy's Curse".
John Brown, personal servant and companion to Queen Victoria (d. 1883)^[13]
Miller Huggins, baseball player and manager (d. 1929)
Charles Lamb, English writer and essayist (d. 1834)
Pat Killen, Hard hitting heavyweight boxer of John L Sullivan's era. Some say he hit harder than Sullivan. Died at age 29 while in hiding in Chicago from police after assaulting two men. (d. Oct 10 1891)
Michiel de Ruyter, Dutch admiral during the Anglo-Dutch wars, contracted erysipelas from injuries sustained from a cannonball. (d. 1676)^[14]

Richard Wagner also suffered from erysipelas,^{[citation needed]} although he died of a heart attack.

Other animals

Erysipelas is also the name given to an infection in animals caused by the bacterium Erysipelothrix rhusiopathiae. Erysipelothrix rhusiopathiae can also infect humans, but in that case the infection is known as erysipeloid.

Footnotes

^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. p. 260. ISBN 0-7216-2921-0.
^ "erysipelas" at Dorland's Medical Dictionary
^ Krasagakis K, Samonis G, Maniatakis P, Georgala S, Tosca A (2006). "Bullous erysipelas: clinical presentation, staphylococcal involvement and methicillin resistance". Dermatology 212 (1): 31–5. doi:10.1159/000089019. PMID 16319471.
^ Bisno AL, Stevens DL (January 1996). "Streptococcal infections of skin and soft tissues". The New England Journal of Medicine 334 (4): 240–5. doi:10.1056/NEJM199601253340407. PMID 8532002.
^ See eMedicine link
^ Koster JB, Kullberg BJ, van der Meer JW (March 2007). "Recurrent erysipelas despite antibiotic prophylaxis: an analysis from case studies". The Netherlands Journal of Medicine 65 (3): 89–94. PMID 17387234.
^ Wollenweber, Brother Leo (2002). "Meet Solanus Casey". St. Anthony Messenger Press, Cincinnati, Ohio, page 107, ISBN 1-56955-281-9,
^ America the Beautiful by Lynn Sherr
^ http://encyclopediavirginia.org/Berkeley_Norborne_baron_de_Botetourt_1717-1770#start_entry
^ Green, Elizabeth Alden (1979). Mary Lyon and Mount Holyoke. Hanover, New Hampshire: University Press of New England. p. 310. ISBN 0-87451-172-0.
^ Capaldi, Nicholas (2004). John Stuart Mill: a biography. Cambridge, UK: Cambridge University Press. p. 356. ISBN 0-521-62024-4.
^ Møller, Jan (1994). Frederik 7. En kongeskæbne. Copenhagen: Aschehoug Dansk Forlag. p. 235. ISBN 978-87-11-22878-4.
^ Ridley, Jane (2013). The Heir Apparent: a life of Edward VII, the Crown Prince. New York, NY: Penguin Random House LLC. p. 287.
^ Entry on Geni.com (Dutch language). Retrieved 10 June 2015.

External links

Erysipelas Overview Health in Plain English - with pictures
Cellulitis Treatment for Skin Infection - Without Pictures

UpToDate Contents

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1. 蜂窩識炎および丹毒 cellulitis and erysipelas
2. 顔面紅斑が認められる患者に対するアプローチ approach to the patient with facial erythema
3. リンパ浮腫の臨床症状および診断 clinical manifestations and diagnosis of lymphedema
4. 成人におけるA群レンサ球菌（Streptococcus pyogenes）性菌血症 group a streptococcal streptococcus pyogenes bacteremia in adults
5. 小児におけるA群レンサ球菌（化膿連鎖球菌）性菌血症 group a streptococcal streptococcus pyogenes bacteremia in children

English Journal

Evidence-based primary care treatment guidelines for skin infections in Europe: A comparative analysis.

van Bijnen EM, Paget J, den Heijer CD, Stobberingh EE, Bruggeman CA, Schellevis FG; in collaboration with the APRES study team.Author information Netherlands Institute for Health Services Research (NIVEL) , Utrecht , The Netherlands.AbstractBackground: In Europe, most antibiotics for human use are prescribed in primary care. Incorporating resistance data into treatment guidelines could improve appropriate prescribing, increase treatment effectiveness and control the development of resistance. Objectives: This study reviews primary care treatment guidelines for bacterial skin infections across Europe and assesses to what extent they are based on antibiotic resistance data. Methods: Thirteen primary care treatment guidelines were obtained from eight countries across Europe. Both the treatment recommendations and the underlying evidence were assessed. The class and dose of recommended antibiotics were investigated and compared using the World Health Organisation's standardized volume of Defined Daily Dose. Furthermore, analysis investigated whether guidelines included references to scientific publications about antibiotic resistance data, and whether these were of national origin. Results: Guidelines were included regarding common skin infections in primary care: Impetigo, Cellulitis, Erysipelas, Folliculitis and Furuncle. Results showed a high agreement across Europe: all recommended antibiotics are of the beta-lactam class and mainly in the small spectrum. The advised treatment durations are consistent; the dosages, however, vary considerably, with the highest dosages recommended in Sweden. Seven guidelines (54%) did not include scientific references related to resistance. Conclusion: There may be a lack of relevant national data on resistance. This study highlights the need to collect more national resistance data (particularly regarding beta-lactams) to create stronger evidence-based treatment guidelines for skin infections in Europe.
The European journal of general practice.Eur J Gen Pract.2014 Jan 23. [Epub ahead of print]
Background: In Europe, most antibiotics for human use are prescribed in primary care. Incorporating resistance data into treatment guidelines could improve appropriate prescribing, increase treatment effectiveness and control the development of resistance. Objectives: This study reviews primary care
PMID 24456348

Comparison of Digital Planimetry and Ruler Technique To Measure ABSSSI Lesion Sizes in the ESTABLISH-1 Study.

Bien P, De Anda C, Prokocimer P.Author information Department of Clinical Research, Cubist Pharmaceuticals , San Diego, California.AbstractAbstract Background: In August 2010, the U.S. Food and Drug Administration issued draft guidelines for developing antibiotics for treating acute bacterial skin and skin structure infections (ABSSSI), with the outcome measure of such treatment relying primarily on the cessation of spread or on the decrease in size of skin lesions at 48-72 h after the initiation of such treatment. In 2012, the Foundation for the National Institutes of Health proposed an interim outcome measure defined as a reduction in lesion size by ≥20% at a 48-72 h examination. These recent changes make it necessary to identify reliable methods for measuring the lesions in acute infections of the skin. Methods: In the first study of the Efficacy and Safety of 6-day Oral Tedizolid in Acute Bacterial Skin and Skin Structure Infections vs. 10-day Oral Linezolid Therapy (ESTABLISH-1), the sizes of ABSSSI lesions were evaluated with the two methodologies of: (1) Digital planimetry (DP) of photographed lesions, and (2) a ruler technique (RT) with measurement of the longest head-to-toe length and greatest perpendicular width of lesions, to compare the respective response rates of lesions to the two antimicrobial regimens in the study. Results: The RT method and DP showed similar percentages of subjects in which treatment stopped the spread of ABSSSI lesions (93.2% vs. 94.2%, respectively) but showed less agreement for a reduction in lesion size, of ≥20% (87.7% vs. 62.0%, respectively) across all categories of lesions (cellulitis/erysipelas, major cutaneous abscess, and acute wound infection) at 48-72 h after the initiation of treatment. Conclusion: The results of the ESTABLISH-1 study show that both the RT method and DP are consistent and reliable techniques for measuring the sizes of ABSSSI lesions. Ultimately, changes in lesion size, rather than the absolute value of lesion size, will be used to assess the outcomes of treatment for ABSSSI in clinical research.
Surgical infections.Surg Infect (Larchmt).2014 Jan 22. [Epub ahead of print]
Abstract Background: In August 2010, the U.S. Food and Drug Administration issued draft guidelines for developing antibiotics for treating acute bacterial skin and skin structure infections (ABSSSI), with the outcome measure of such treatment relying primarily on the cessation of spread or on the de
PMID 24450727

An unusual erysipelas-like presentation.

Siah TW, Lavender T, Charlton F, Wahie S, Schwab U.Author information University Hospital of North Durham. s310tw@doctors.org.uk.AbstractA 61-year-old man presented with erysipelas-like cutaneous leishmaniasis.
Dermatology online journal.Dermatol Online J.2014 Jan 15;20(1):21255.
A 61-year-old man presented with erysipelas-like cutaneous leishmaniasis.
PMID 24456958

Japanese Journal

整形外科診療で役立つ皮膚細菌感染症の臨床 (特集整形外科診療に役立つ皮膚科の知識)

整形・災害外科 58(12), 1583-1591, 2015-11
NAID 40020631134

今月の症例丹毒様の臨床像を呈し好酸球性膿疱性毛包炎の組織像を示したクロムによる接触皮膚炎

臨床皮膚科 = Japanese journal of clinical dermatology 69(3), 184-187, 2015-03
NAID 40020368776

臨床統計丹毒・蜂窩織炎86例の検討

臨床皮膚科 = Japanese journal of clinical dermatology 69(2), 163-167, 2015-02
NAID 40020334312

Related Pictures

★リンクテーブル★

リンク元	「丹毒」「痂皮性伝染性膿痂疹」「erysipelatous」

「丹毒」

Erysipelas
	Erysipelas of the face due to invasive Streptococcus.
Classification and external resources
ICD-10	A46.x
ICD-9	035
DiseasesDB	4428
MedlinePlus	000618
eMedicine	derm/129
MeSH	D004886

　　[★]

英: erysipelas, rose
関: A群β溶連菌

概念

真皮レベルの軟部組織感染症

好発部位

下肢：80%を占める(Recurrent erysipelas - risk factor and clinical presentation; Inghammar et al. BMC Infectious Diseases 2014,14:270)

病原体

症状

境界明瞭な発赤
腫脹
圧痛
熱感

血液検査

白血球増多
CRP上昇
赤沈亢進
ASO,ASK上昇

国試

104I072

-erysipelas

「痂皮性伝染性膿痂疹」

　　[★]

英: crusted impetigo contagiosa
関: 細菌感染症、膿痂疹、水疱性伝染性膿痂疹

A群β溶血性連鎖球菌(Streptococcus pyogenes)が角層下に感染する　→　真皮への感染　丹毒 erysipelas

「erysipelatous」

　　[★]

丹毒の

関: erysipelas

[Andrews-1] James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. p. 260. ISBN 0-7216-2921-0.

[2] "erysipelas" at Dorland's Medical Dictionary

[bullous-3] Krasagakis K, Samonis G, Maniatakis P, Georgala S, Tosca A (2006). "Bullous erysipelas: clinical presentation, staphylococcal involvement and methicillin resistance". Dermatology 212 (1): 31–5. doi:10.1159/000089019. PMID 16319471.

[4] Bisno AL, Stevens DL (January 1996). "Streptococcal infections of skin and soft tissues". The New England Journal of Medicine 334 (4): 240–5. doi:10.1056/NEJM199601253340407. PMID 8532002.

[5] See eMedicine link

[pmid17387234-6] Koster JB, Kullberg BJ, van der Meer JW (March 2007). "Recurrent erysipelas despite antibiotic prophylaxis: an analysis from case studies". The Netherlands Journal of Medicine 65 (3): 89–94. PMID 17387234.

[7] Wollenweber, Brother Leo (2002). "Meet Solanus Casey". St. Anthony Messenger Press, Cincinnati, Ohio, page 107, ISBN 1-56955-281-9,

[8] America the Beautiful by Lynn Sherr

[9] ttp://encyclopediavirginia.org/Berkeley_Norborne_baron_de_Botetourt_1717-1770#start_entry

[Alden-10] Green, Elizabeth Alden (1979). Mary Lyon and Mount Holyoke. Hanover, New Hampshire: University Press of New England. p. 310. ISBN 0-87451-172-0.

[isbn0-521-62024-4-11] Capaldi, Nicholas (2004). John Stuart Mill: a biography. Cambridge, UK: Cambridge University Press. p. 356. ISBN 0-521-62024-4.

[12] Møller, Jan (1994). Frederik 7. En kongeskæbne. Copenhagen: Aschehoug Dansk Forlag. p. 235. ISBN 978-87-11-22878-4.

[isbn.3D978-1400062553-13] Ridley, Jane (2013). The Heir Apparent: a life of Edward VII, the Crown Prince. New York, NY: Penguin Random House LLC. p. 287.

[14] Entry on Geni.com (Dutch language). Retrieved 10 June 2015.

匿名

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案内

案内

erysipelas